Complicated appendiceal diverticulitis a extremely rare cause of acute abdomen: A case report and literature review.

Introduction And Importance: Appendiceal diverticulitis (AD) represents a rare cause of acute abdomen. Diagnosis of AD is a challenge because of its rarity and resemblance to other ileocecal diseases like as cecal diverticulitis (CD) and acute appendicitis (AA). Preoperative imaging can be useful to aid diagnosis.

Accidentally ingested wooden toothpick, perforation of a sigmoid diverticulum and mimicking acute colonic diverticulitis: A case report and literature review.

Introduction And Importance: Ingested wooden toothpick (WT) represents a rare cause of acute abdomen. Preoperative diagnosis of ingested WT is a challenge because of its unspecific clinical presentation, the low sensitivity rate of radiological investigations and the patient's inability to often recall the event of swallowing a WT. Surgery represents the main treatment in case of ingested WT-induced complications.

Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience.

Background: During recent years laparoscopic cholecystectomy has dramatically increased, sometimes resulting in overtreatment. Aim of this work was to retrospectively analyze all laparoscopic cholecystectomies performed in a single center in order to find the percentage of patients whose surgical treatment may be explained with this general trend, and to speculate about the possible causes.

Methods: 831 patients who underwent a laparoscopic cholecystectomy from 1999 to 2008 were retrospectively analyzed.

Health-related quality of life in patients with hepatocellular carcinoma after hepatic resection, transcatheter arterial chemoembolization, radiofrequency ablation or no treatment.

Background: Aim of this work was to compare quality of life (QoL) of patients affected by HCC and submitted to hepatic resection (HR), transarterial chemoembolization (TACE), radiofrequency ablation (RFA), or no treatment (NT).

Methods: Patients affected by HCC between 2001 and 2009 were considered for this study. Gender, diabetes, hepatitis status, Child grade, tumor size, and recurrence were analyzed.

A new technique for spleen autotransplantation.

Purpose: Although the efficacy of spleen autotransplantation is debated, this approach remains the only possibility for preserving splenic function after traumatic splenectomy. This report describes an alternative method for splenic autotransplantation in case of splenic trauma.

Methods: After splenectomy, the organ was weighed and the undamaged part was cut transversely to prepare a segment of approximately 4 × 3 × 2 cm in size and of 35 g of weight to be transplanted.

Parenchymal compression and new devices for hepatic resections: re-visitation of an old technique.

Background/aims: This reports on the modification of a technique of parenchymal compression ideated to reduce blood loss during liver transection, favorably affecting patient's outcome by reducing the need of Pringle maneuver and operative time through the active role of the second surgeon.

Methodology: After echographic examination a water-cooled, high-density, monopolar dissecting sealer is introduced into the hepatic parenchyma allowing pre-coagulation of liver tissue. After coagulation of the traced line, a small Kelly forceps is used to fracture the liver parenchyma.

Localized fluid collection after carrier-bound fibrin sealant application on liver: complication or proof of efficacy? A long-term clinical observational study.

Background/aims: This study was intended to evaluate the incidence and the long-term outcome of fluid collecting between the hepatic resection surface and a collagen patch. To our knowledge, this is the first study to analyze these aspects.

Methodology: All patients undergoing hepatic resection with patch application from February 2006 to September 2008 were included.

Seizure attack and Morgagni diaphragmatic hernia: incidental diagnosis or direct correlation?

Asymptomatic Morgagni hernia can be discovered in adults as an incidental finding or because of acute gastrointestinal symptoms. We report a case of a 76-year-old man with an incidental diagnosis of seizure attack. Obesity and the increased abdominal pressure caused by abdominal muscles contraction during seizure could have contributed to the clinical presentation.

An update on indications for treatment of solid hepatic neoplasms in noncirrhotic liver.

During recent years, we have experienced an increased detection of previously unsuspected liver masses in otherwise asymptomatic patients owing to the widespread application of imaging techniques. Regardless of the malignant or cystic tissues, a remarkable percentage of these masses are represented by benign solid neoplasms. Treatment of benign liver tumors still represents a major concern in the hepatic surgery field.

May the method of hepatic parenchymal transection influence early results of liver surgery?

Background/aims: Aim of this work was to analyze retrospectively two groups of patients who underwent hepatic resection using two different techniques, to determine whether exists a difference in hepatic tolerance and in the early outcome.

Methodology: We retrospectively analyzed seventy-one patients divided into group 1, treated with kellyclasia and Pringle maneuver, and group 2 treated with a radiofrequency device. The following parameters were analyzed: age; sex; type of disease, number of major/minor resections; total operative time and transection time; number and time of clampings; blood loss; pre- and postoperative transaminases and total bilirubin; length of hospitalization; morbidity and mortality.

Laparoscopic versus open restoration of intestinal continuity after Hartmann procedure.

Background/aims: To present the initial experience with laparoscopic technique of restoration after Hartmann procedure compared to open surgery.

Methodology: All patients submitted to Hartmann procedure from 2003 to 2008 were considered. The following parameters were evaluated: age, gender, comorbidities, American Society of Anesthesiologists score, indication for the procedure, Hinchey scale, interval between Hartmann and reversal procedure, total operative time of Hartmann reversal, pain management, delay in renewal of peristalsis, start of alimentation, length of hospital stay, morbidity, and mortality.

Adenoma or atypical hepatic focal nodular hyperplasia: role of preoperative imaging and laparoscopic treatment.

Differentiation of focal nodular hyperplasia (FNH) and other hypervascular liver lesions, such as hepatocellular adenoma (HCA), is important because of the drastically different therapeutic approach. However, FNH can be well distinguished only if it shows a typical aspect; alternatively, in the case of atypical FNH, imaging findings are not specific enough to provide a secure diagnosis and histologic verification of the lesion is required. In addition, HCA cannot be identified conclusively by any current available imaging technique and it can be at best suspected strongly, and this suspicion may lead to liver resection.

Is laparotomy the unavoidable step to diagnose caecal volvulus?

Caecal volvulus is the axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. This infrequently encountered clinical entity is responsible for 1-1.5% of all intestinal obstruction with a mortality of 10-40% depending on the presence of colon viability or intestinal gangrene.

Sacroplasty in a patient with bone metastases from hepatocellular carcinoma. A case report.

Bone metastases account for 10% to 30% of secondary tumors in all cancer types. In patients with primary hepatocellular carcinoma (HCC), bone metastases are usually treated by nonoperative procedures including pain medication, radiotherapy, hormone therapy, chemotherapy, and bisphosphonates. Surgical treatments include vertebrectomy, reconstruction with a cage or polymethylmethacrylate bone cement, and stabilization with pedicle screws.

An unusual association of diffuse adenomyomatosis with dysplastic adenoma in chronic calculous cholecystitis: case presentation.

Background: Gallbladder adenomyomatosis is an epithelial proliferation and hypertrophy of the muscularis mucosae of the gallbladder. Rokitansky-Aschoff sinuses are a characteristic of this condition. The segmental adenomyomatosis has a higher risk of developing into gallbladder carcinoma, especially in the fundal region of elderly patients.

Simultaneous transarterial and portal embolization for unresectable tumors of the liver.

Hepatic portal vein embolization and transcatheter arterial chemoembolization are well-defined procedures respectively introduced to increase the future remnant liver and to avoid tumor progression before a scheduled hepatectomy. If used alone, both this approaches do not always improve surgical outcome, sometimes resulting in drop out from definitive surgery because of progression of disease. Since the late 1980s, sequential approach with TACE and PVE has been introduced as a preoperative treatment in order to: prevent tumor progression during the weeks intervening before operation; strengthen the effects of PVE by embolizing possible arterio-portal shunts; improve the FRL volumetric increase through the acceleration of hepatocytes proliferation.

Increased use of percutaneous technique for totally implantable venous access devices. Is it real progress? A 27-year comprehensive review on early complications.

Background: First implantation of a totally implantable venous access device (TIVAD) was performed in 1982 with surgical technique. Since then, these devices have permitted infusion of total parenteral nutrition, antibiotics, blood products, and, above all, they have definitively changed the quality of life of patients with cancer. However, with the increase of percutaneous procedures, we have assisted with a concomitant raise of immediate postprocedural life-threatening complications.

Update on Instrumentations for Cholecystectomies Performed via Transvaginal Route: State of the Art and Future Prospectives.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an innovative approach in which a flexible endoscope enters the abdominal cavity via the transesophageal, transgastric, transcolonic, transvaginal or transvescical route, combining the technique of minimally invasive surgery with flexible endoscopy. Several groups have described different modifications by using flexible endoscopes with different levels of laparoscopic assistance. Transvaginal cholecystectomy (TVC) consists in accessing the abdominal cavity through a posterior colpotomy and using the vaginal incision as a visual or operative port.

Pneumoscrotum due to perforated peptic ulcer previously sutured by laparoscopy.

Pneumoscrotum is a rare condition defined by the presence of gas within the scrotum. Most cases are associated with the pneumoperitoneum; the condition has been described after various diagnostic and therapeutic procedures and disease conditions. In this article, we report a case of a patient admitted to the emergency department for right-upper quadrant abdominal pain.

Could antibiotic prophylaxis be not necessary to implant totally implantable venous access devices? Randomized prospective study.

Background: The growing use of totally implantable venous access devices (TIVAD) has caused the simultaneous increase of various complications. Among these, one of the most encountered is the infection of the subcutaneous pocket in which the device is positioned, or the infection of TIVAD itself. The aim of this study is to evaluate the role of the antibiotic in the prevention of the infection of both the surgical site and the TIVAD within 30 days after the implant.